Chest x-ray in clinical practice

200 Pages·2009·15.18 MB·English

by  Dr Rita Joarde

Chest X-Ray
in Clinical Practice
·
Rita Joarder Neil Crundwell
Editors
Chest X-Ray
in Clinical Practice
123
Editors
Dr.RitaJoarder Dr.NeilCrundwell
ConquestHospital ConquestHospital
TheRidge TheRidge
St.Leonards-On-Sea St.Leonards-On-Sea
EastSussex EastSussex
UnitedKingdomTN377RD UnitedKingdomTN377RD
[email protected] [email protected]
ISBN978-1-84882-098-2 e-ISBN978-1-84882-099-9
DOI10.1007/978-1-84882-099-9
SpringerDordrechtHeidelbergLondonNewYork
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‘ToMartin,Alfred,Arnold,andFreddie,
foryourunceasingsupportand
inspiration’RitaJoarder
‘ToLesleyandSebastianforshowingme
life’sbeautifulthings’NeilCrundwell
Preface
Thechestradiograph(chestX-ray)isthemostcommonlyre-
questedexamination,anditisprobablythehardestplainfilm
tointerpretcorrectly.Accurateinterpretationcangreatlyin-
fluence patient management in the acute setting. It is, how-
ever, often performed out of hours and the interpretation is
undertakenbyrelativelyjuniormembersofstaffwithnoim-
mediate senior support or radiological input. Despite the in-
creasing availability of more complex radiological investiga-
tions,thechestX-raycontinuestoberequestedasafirst-line
investigationandthisislikelytocontinue.
The structure of this book derives from many teaching
sessions that have been given to junior doctors and medi-
cal students. The authors have found that, in general, teach-
ingregardingchestX-rayinterpretationhadlackedaformal
structuredapproach,andjuniordoctorsandmedicalstudents
foundinterpretingachestX-raydifficult.Givingthemastruc-
tured approach allowed them to feel they could tackle inter-
pretationwithmoreconfidence.
Weaimtoprovideaportablehandbookforjuniordoctors.
The structure is based upon those lectures that the authors
havegiven.Thebookitselfisintendedtobeeasilyaccessible
and to help this we have included tables containing the key
teachingpoints,toalloweasyreference.Wehaveincludedex-
tensiveexamplesofcommonpathologies.Thisbookis,how-
ever,notanexhaustiveworkofreference.
We have included basic information on how a chest X-ray
isperformedandhowsuchperformancefactorscanaffectthe
quality of the image. We consider the implications of radia-
tion dose and give details of basic normal anatomy. We then
explainwhynormalstructuresappearastheydoonthechest
vii
viii Preface
X-ray.Theabilitytointerpretthenormaliskeytointerpret-
ingtheabnormalandweexplainwhyabnormalitiescreatethe
imagingfeaturestheydo.
Using a structured logical approach, we focus on both
anatomical abnormality and more generalized patterns of
lungdisease.
Our ultimate aim is to equip the reader with a confident,
simplebutlogicalapproachtochestX-rayinterpretation.
R.Joarder
N.Crundwell
Acknowledgments
We would like to acknowledge Christina Worley for all her
hardworkinpreparingthemanuscript.
We would also like to acknowledge the following for
their valuable contribution to this book: Steve Page, DCR,
MSc, Conquest Hospital, St Leonards-On-Sea, East Sussex,
UK, and Andrew Develing, DipMDI, Conquest Hospital, St
Leonards-On-Sea,EastSussex,UK
ix
Contents
Preface............................................. vii
Acknowledgments .................................. ix
PartI
1 ChestRadiography ............................. 3
1.1. RadiographicTechnique .................... 4
1.1.1. Postero-anterior(PA) ................ 4
1.1.2. Antero-posterior .................... 6
1.1.3. Lateral ............................. 7
1.1.4. Obliques............................ 9
1.1.5. PenetratedPostero-anterior .......... 12
1.1.6. Inspiration/ExpirationPostero-anterior 12
1.1.7. ApicalLordotic ..................... 12
1.2. KeyPoints................................. 13
2 The Normal Chest X-ray: An Approach
toInterpretation................................ 15
2.1. UnderstandingNormalAnatomy ............ 17
2.2. ReviewAreas.............................. 22
2.3. Pseudo-abnormalitiesonaNormalFilm ...... 24
2.4. KeyPoints................................. 27
PartII
3 TheMediastinumandHilarRegions ............. 31
3.1. MiddleMediastinumandHilarRegions ...... 34
xi
xii Contents
3.1.1. CardiacAbnormality................. 34
3.1.2. HilarAbnormalities ................. 42
3.1.3. OtherMiddleMediastinalAbnormalities 45
3.2. AnteriorMediastinum ...................... 48
3.3. PosteriorMediastinum...................... 49
3.3.1. HiatusHernia ....................... 51
3.3.2. Gastric Pull Through Following
Oesophagectomy .................... 51
3.3.3. OesophagealDilatation .............. 53
3.3.4. Descending Thoracic Aortic
Abnormalities ....................... 54
3.4. KeyPoints................................. 54
4 BasicPatternsofLungDisease .................. 55
Introduction.................................... 55
4a Consolidation .................................. 57
4.1. ExamplesofConsolidationandItsCauses .... 60
4.1.1. Infection............................ 60
4.1.2. PulmonaryOedema.................. 63
4.1.3. Malignancy ......................... 64
4.1.4. Haemorrhage ....................... 65
4.2. KeyPoints................................. 66
4b Collapse ....................................... 67
4.3. LobarCollapse............................. 67
4.4. RightLung ................................ 68
4.5. LeftLung ................................. 70
4.6. WholeLungCollapse....................... 72
4.7. KeyPoints................................. 73
4c Lines .......................................... 74
4.8. LeftVentricularFailure ..................... 77
4.9. NormalAgeingLungs ...................... 79
4.10.LymphangitisCarcinomatosis ............... 80
4.11.Fibrosis ................................... 81
4.12.LowerZoneFibrosis ....................... 82
4.13.UpperZoneFibrosis ....................... 83